Fluoroscopy-Guided Percutaneous Transpedicular Biopsy Versus Posterolateral Endoscopy for Infective Spondylodiskitis Diagnosis: A Comparative Study.

OBJECTIVE: We sought to determine the concordance in frequency of microbiologic isolation and species identification in specimens obtained by 2 methods. METHODS: Intervertebral disk specimens were taken simultaneously from each patient using percutaneous needle and posterolateral endoscopic biopsies. The isolates were reported in frequencies and concordance using the chi square and Cohen kappa tests. RESULTS: Thirty patients were recruited. The average age was 58.1 years, and 15 patients were women. The clinical evolution time was 7 ± 4 months. The causative organism was identified in 12 (40%) specimens obtained by fluoroscopy-guided percutaneous transpedicular biopsy and in 14 (46.6%) obtained by posterolateral endoscopy. The most common organism isolated was Staphylococcus aureus in 3 patients with the percutaneous technique and in 5 with the endoscopic one; Escherichia coli was isolated in 3 patients with each method. The kappa test showed a high degree of agreement between both methods (kappa = 0.86); the agreement in bacterial species identification was 100%. CONCLUSIONS: Fluoroscopy-guided percutaneous biopsy and endoscopic sampling have a good degree of concordance for both, frequency of organism isolation and identification in patients with infectious spondylodiskitis.

Diagnostic Yield of Computed Tomography-Guided Procedures for Spondylodiscitis.

PURPOSE: To identify the diagnostic yield and predictive factors for microbiological diagnosis in patients with spondylodiscitis through computed tomography (CT)-guided biopsy or aspiration. MATERIALS AND METHODS: A retrospective review of 102 patients with suspected spondylodiscitis who underwent CT-guided procedures in an 8-year period was conducted. Analyzed variables were demographic data, C-reactive protein, pre-biopsy MRI findings, prior antibiotic use, site of biopsy/aspiration, histopathological findings, culture results and radiation dose. RESULTS: The culture yield among all sites was 56%, 85.6% for paravertebral/discal fluid aspiration, 66.7% for disk-only biopsy, 52.9% for paravertebral soft tissue biopsy, and 39.6% for endplate bone-disk unit. Patients with paravertebral/disk collection on MRI had better yields when submitted to fluid aspiration instead of biopsy of other sites (78.9% vs. 36.6%; p = 0,006). Pyogenic etiology corresponded to 68.3% of cases and Staphylococcus aureus was the most common agent. Prior antibiotics exposure was associated with a lower yield (66.2% vs. 40.9%, p = 0,016). CONCLUSIONS: CT-guided procedures are safe and well-tolerated in patients with suspected spondylodiscitis, with good microbiologic yield particularly in the presence of paravertebral/discal abscess.

Candida Tropicalis Spondylodiscits in an Immunocompetent Host: A Case Report and Literature Review

Background Fungal spondylodiscitis is not common but should be suspected in some cases. Candida tropicalis infections are being more frequently diagnosed due to some factors related to the microorganism. Case Description A C. tropicalis spondylodiscitis is described in a 72-year-old man who was treated with a combination of echinocandin (micafungin) and surgery. Conclusion The presence of some risk factors should promptly raise the suspicion of fungal spondylodiscitis. Treatment should be instituted as early as possible for the best outcome for the patient.

Spondylodiscitis treated with freeze-dried bone allograft alone or combined with autograft: A randomized and blinded trial.

PURPOSE: To compare the bone fusion of freeze-dried allograft alone versus freeze-dried allograft combined autograft in spinal instrumentation due to spondylodiscitis. METHODS: A randomized prospective trial of patients with spondylodiscitis treated with surgical debridement and spinal fixation with freeze-dried bone allograft and autograft (Group 1) or freeze-dried bone allograft alone (Group 2) was performed. Patient follow-up was assessed with a CT-scan for bone fusion; consecutive serum inflammatory marker detection (C-reactive protein, [CRP], and erythrocyte sedimentation rate, [ESR]) and clinical assessment (pain, functional disability, and spinal cord injury recovery) were other outcome parameters. The primary outcome was the grade of bone allograft integration with the scale of Tan (which ranges from 1 to 4, with lower scores indicating a better fusion rate) at 1 year after surgery. RESULTS: A total of 20 patients were evaluated, 13 (65%) men and 7 (35%) women with a mean age of 47.2 (±14.3) years. Homogeneous distribution of demographic data was observed. A similar satisfactory bone graft fusion grade was observed in both graft groups at 1 year after surgery (p = 1.0000). Serum inflammatory markers gradually decreased in both groups after surgical intervention (CRP, p < 0.001; ESR, p < 0.01). At one-year follow-up, gradual improvement of pain, functional disability, and neurological spinal injury recovery in both graft groups were achieved. CONCLUSION: Freeze-dried allograft alone could be a therapeutic option for spinal fixation surgery due to spondylodiscitis since it achieves a satisfactory graft fusion rate and clinical improvement. LEVEL OF EVIDENCE: Level 1. Treatment. REGISTER: NCT03265561.

Change in Bone CT Attenuation and C-reactive Protein Are Predictors of Bone Biopsy Culture Positivity in Patients With Vertebral Discitis/Osteomyelitis.

STUDY DESIGN: Case-control study. OBJECTIVE: The objective of this study was to identify the best laboratory and imaging factors to predict bone biopsy culture positivity in the setting of vertebral discitis/osteomyelitis (VDO). SUMMARY OF BACKGROUND DATA: Good predictors of bone biopsy culture positivity in the setting of VDO are unknown. METHODS: Retrospective review was performed for 46 patients who underwent CT-guided bone biopsy for the evaluation of clinically confirmed VDO. Erythrocyte sedimentation rate, C-reactive protein (CRP), mean CT attenuation of the biopsied bone, and the change in the CT attenuation of the bone compared to unaffected vertebral bone (delta CT attenuation) were measured. Receiver-operator characteristic curve analyses were performed to identify the optimal threshold value for each variable. A multivariable logistic regression model was used to predict the probability of a positive bone culture using delta CT attenuation and CRPx100% fold above normal. RESULTS: For one of the 46 VDO patients, bone cultures were not obtained. Approximately 35.6% (16/45) of bone cultures were positive. The most significant predictors of bone culture positivity were CRP x100% fold above normal (P = 0.011) and delta CT attenuation (P = <0.001). Optimized predictive thresholds were calculated to be CRP 4-fold above normal reference value (90.9% sensitivity, 73.7% specificity), or if the CT attenuation of the affected vertebral body was >25.9 HU lower relative to unaffected bone (93.8% sensitivity, 75.0% specificity). CONCLUSION: Delta CT attenuation, as well as CRP level over four times the upper limits of normal, were the strongest predictors for bone culture positivity in patients with VDO. LEVEL OF EVIDENCE: 3.

High cervical spine spondylodiscitis management and literature review.

Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

High cervical spine spondylodiscitis management and literature review / Espondilodiscite da coluna cervical alta: manejo e revisão da literatura

Summary Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

Resumo A espondilodiscite, que acomete a coluna cervical, é a de localização mais rara. Pode ter uma evolução dramática, inclusive causando tetraplegia e óbito. Apresentamos um caso atípico que evoluiu com lesões osteolíticas entre C2 e C3, causando compressão medular e abscesso epidural. O paciente foi submetido a tratamento cirúrgico por dupla abordagem e evoluiu bem, sem déficits neurológicos e com melhora dos marcadores inflamatórios. Revisamos a literatura vigente sobre o assunto.

Espondilodiscitis secundaria a herida por arma blanca / Spondylodiscitis Secondary to Stab Wound

La Espondilodiscitis es una de las formas de presentación de procesos infecciosos en el raquis. Se puede observar en pacientes inmunodeprimidos o secundaria a intervenciones locales como bloqueos o procederes de mínimo acceso sobre la columna. Teniendo en cuenta la inusual aparición de la espondilodiscitis secundaria a traumas punzantes, y a la presencia de signos imagenológicos tempranos capaces de mostrar la propagación de la infección desde el sitio de la lesión hasta el segmento vertebral, se presenta este caso de espondilodiscitis secundaria a herida por arma blanca. Se presenta un paciente masculino de 48 años de edad con antecedentes de salud anterior, que sufrió una herida por arma blanca en la región lumbar izquierda, posterior al trauma comenzó a presentar dolor en columna lumbar e impotencia funcional absoluta. Se le realizan estudios de laboratorio y de imágenes. Los parámetros hematológicos inclinaban al diagnóstico de un proceso infeccioso en la columna y la Resonancia Magnética Nuclear evidenció una espondilodiscitis lumbar, así como el trayecto fistuloso de la infección desde la piel hasta el segmento afectado. El tratamiento consistió en la administración de antibióticos e inmovilización con un corsé por 6 meses. El paciente presentó mejoría de los síntomas a las 3 semanas, con alivio total del dolor al mes. Los resultados hematológicos mejoraron paulatinamente hasta alcanzar la normalidad a los 6 meses. La Espondilodiscitis producida por herida de arma blanca constituye una condición infrecuente, pero debe ser sospechada en todo paciente que sufra este tipo de lesión(AU)

Spondylodiscitis is one of the forms of presentation of infectious processes in the rachis. It can be observed in immunocompromised patients or secondary to local interventions such as blockages or procedures of minimal access to the spine. Given the unusual occurrence of spondylodiscitis secondary to sharp trauma, and the presence of early imaging signs capable of showing the spread of the infection from the site of the lesion to the vertebral segment, a case of spondylodiscitis secondary to stab injury is presented. We report a 48-year-old male patient with previous health history, who suffered a stab wound in the left lumbar region. After trauma, he began to present pain in the lumbar spine and absolute functional impotence. Laboratory and imaging studies are performed. The hematological parameters inclined to the diagnosis of an infectious process in the column and the nuclear magnetic resonance evidenced lumbar spondylodiscitis, as well as the fistulous path of the infection from the skin to the affected segment. Treatment consisted of administration of antibiotics and immobilization with a corset during 6 months. The patient presented improvement of symptoms at 3 weeks, with total pain relief at one month. The hematological results gradually improved until reaching normality at 6 months. Spondylodiscitis produced by knife wounding is uncommon condition, but it should be suspected in any patient suffering from this type of injury(AU)

Mal de Pott en un indígena colombiano / Pott´s disease in a Colombian indigenous man

Cada año mueren alrededor de dos millones de personas a causa de la tuberculosis y se estima que un tercio de la población mundial está infectada con el bacilo que la causa, pero solo entre 5 y 10 % desarrolla la enfermedad. El riesgo de que la enfermedad progrese al estado activo depende de factores endógenos y exógenos. Las comunidades indígenas son un grupo con un alto riesgo de infectarse y enfermar de tuberculosis; además de factores como el aislamiento geográfico, el abandono social y cultural y la desnutrición, se han identificado en ellos polimorfismos genéticos que los hacen más propensos a la infección. La tuberculosis vertebral es la forma más destructiva de la enfermedad y representa cerca de la mitad de los casos de tuberculosis esquelética. Se presenta el caso de un paciente indígena colombiano con tuberculosis vertebral y resultado negativo para HIV. El diagnóstico se basó en los hallazgos clínicos y en los estudios de imaginología, y se confirmó mediante la prueba molecular rápida Genotype MTBDR plus ® y de la reacción en cadena de la polimerasa PCR IS6110; el cultivo fue negativo a las 16 semanas de incubación. Se discuten brevemente la patogénesis, el diagnóstico y el tratamiento, y se comentan algunos aspectos relacionados con la situación de la tuberculosis en las comunidades indígenas colombianas.

Approximately 2 million people die each year from tuberculosis. One third of the world´s population is estimated to be infected with the tuberculosis bacillus, although only 5-10% will develop the disease in their lifetime. The disease progression risk depends on endogenous and exogenous factors. Indigenous communities are a high-risk group for infection and development of tuberculosis. In addition to factors such as geographical isolation, social and cultural neglect and malnutrition, susceptibility to genetic polymorphisms has been identified in them. Spinal tuberculosis is the most destructive form of the disease, which represents approximately half of all cases of skeletal tuberculosis. The case of an HIV negative, indigenous Colombian man is presented. His diagnosis was done based on clinical and image findings, and it was confirmed with the rapid molecular assay Genotype MTBDRplus ® and IS6110 PCR.The culture in solid media was negative after 16 weeks. We briefly discuss the pathogenesis, diagnosis and treatment. Finally, we comment on some aspects of the situation of tuberculosis among indigenous Colombian communities.

[Pott's disease in a Colombian indigenous man]. / Mal de Pott en un indígena colombiano.

Approximately 2 million people die each year from tuberculosis. One third of the world´s population is estimated to be infected with the tuberculosis bacillus, although only 5-10% will develop the disease in their lifetime. The disease progression risk depends on endogenous and exogenous factors. Indigenous communities are a high-risk group for infection and development of tuberculosis. In addition to factors such as geographical isolation, social and cultural neglect and malnutrition, susceptibility to genetic polymorphisms has been identified in them. Spinal tuberculosis is the most destructive form of the disease, which represents approximately half of all cases of skeletal tuberculosis. The case of an HIV negative, indigenous Colombian man is presented. His diagnosis was done based on clinical and image findings, and it was confirmed with the rapid molecular assay Genotype MTBDRplus® and IS6110 PCR.The culture in solid media was negative after 16 weeks. We briefly discuss the pathogenesis, diagnosis and treatment. Finally, we comment on some aspects of the situation of tuberculosis among indigenous Colombian communities.

Infectious spondylodiscitis: has there been any evolution in the diagnostic and treatment outcomes? / Espondilodiscite infecciosa: houve evolução nos resultados do diagnóstico e tratamento? / ¿Espondilodiscitis infecciosa: hubo evolución en los resultados del diagnóstico y tratamiento?

Objective: To evaluate the clinical and radiological results of treatment of patients with spondylodiscitis. Methods: Imaging exams used in this study were plain radiographs and magnetic resonance imaging of the spine. Results: Data from 33 patients, 10 (30.3%) females and 23 (69.7%) males were evaluated. The average time to diagnosis was four months and 28 days (SD ± 1 month and 28 days) and 19 patients (57.5%) presented neurological deficit. Surgical treatment was performed in 22 patients (66.6%) and three patients (9.1%) had complications from the surgery. Conclusions: Despite technological advances in complementary exams, early diagnosis of spondylodiscitis remains a challenge. However, drug treatment associated with surgery shows good results. .

Objetivo: Avaliar os resultados clínicos e radiológicos do tratamento de pacientes portadores de espondilodiscite. Métodos: Os exames de imagem utilizados neste estudo foram radiografias simples e ressonância magnética da coluna vertebral. Resultados: Foram avaliados os dados de 33 pacientes, sendo 10 (30,3%) do sexo feminino e 23 (69,7%) do sexo masculino. O tempo médio gasto para o diagnóstico foi de 4 meses e 28 dias (DP ± 1 mês e 28 dias) e 19 pacientes (57,5%) apresentavam déficit neurológico. O tratamento cirúrgico foi realizado em 22 pacientes (66,6%) e três pacientes (9,1%) apresentaram complicações decorrentes do tratamento cirúrgico. Conclusões: Apesar do avanço tecnológico nos exames complementares, o diagnóstico precoce da espondilodiscite continua sendo um desafio. No entanto, o tratamento medicamentoso associado ao procedimento cirúrgico apresenta bons resultados. .

Objetivo: Evaluar los resultados clínicos y radiológicos de tratamiento de pacientes con espondilodiscitis. Métodos: Las pruebas de imagen utilizadas en este estudio fueron las radiografías simples y resonancia magnética de la columna vertebral. Resultados: Los datos de 33 pacientes, 10 (30,3 %) del sexo femenino y 23 (69,7%) del sexo masculino fueron evaluados. El tiempo medio hasta el diagnóstico fue de 4 meses y 28 días (DE ± 1 mes y 28 días) y 19 pacientes (57,5%) tuvieron déficit neurológico. El tratamiento quirúrgico se realizó en 22 (66,6%) pacientes y 3 (9,1%) tuvieron complicaciones de la cirugía. Conclusiones: A pesar de los avances tecnológicos en los exámenes complementares, el diagnóstico precoz de espondilodiscitis sigue siendo un desafío. Sin embargo, el tratamiento farmacológico asociado con la cirugía presenta buenos resultados. .

Spinal infections in children: a review.

Spondylodiscitis affects children aged between two and eight years, and mainly involves the lumbar or lumbosacral spine. Diagnosis is difficult because the symptoms are not very specific and due to the children's difficulty in communicating. Unlike adults, children have vascularised intervertebral discs, which explains the higher incidence of this disease in this age group. C-reactive protein, and blood and urine cultures are important laboratory tests. In most cases, fine needle or traditional biopsy helps identify the pathogen particularly in patients who do not respond to the antibiotic therapy test. Magnetic resonance imaging has high sensitivity and specificity in the investigation of pyogenic infection of the spine, particularly in the early stages, when these changes are not shown in other imaging tests. X-rays can take up to six weeks to show changes. The first radiographic sign of infection is the irregularity of the vertebral endplates in the infection area, followed by their erosion and that of the adjacent bone, decreased disc space, segmental collapse, loss of lordosis (in cases of low back involvement) and ultimately, permanent structural deformity. After eight to twelve weeks, local regeneration occurs, accompanied by bone sclerosis arising from the formation of new trabecular bone, replacing the necrotic cancellous bone. Effective treatment often leads to bone fusion of the affected disc space. However, when no therapy is adopted, total vertebral collapse can occur. The treatment involves immobilisation, antibiotic therapy, and surgical decompression in more advanced cases.

Espondilodiscitis secundaria a anestesia peridural / Spondilodiscitis secondary to peridural anesthesia

Se presenta el caso de un paciente con espondilodiscitis secundaria al uso de anestesia peridural lumbar para la resección transuretral de una hiperplasia fibroadenomatosa de la próstata. El cuadro clínico estuvo determinado por lumbalgia aguda con incremento progresivo que llevó al confinamiento en cama del paciente. En el examen físico del sistema osteomioarticular predominó la contractura paravertebral lumbar, así como en la palpación de esta región. En el examen neurológico no se encontraron alteraciones. La tomografía axial computarizada multicorte, así como la gammagrafía ósea de columna lumbar, confirmaron el diagnóstico. Se indicó tratamiento médico basado en los síntomas, antibioticoterapia combinada y ortesis externa. La recuperación total del paciente ocurrió a los 6 meses del inicio de la enfermedad(AU)

This is the case of a patient presenting with spondilodiscitis secondary to use of lumbar peridural anesthesia for transurethral resection of a prostatic fibroadenoma hyperplasia The clinical picture was determined by a acute lumbar pain with a progressive increase leading to put to bed the patient. In physical examination of osteomyoarticular system there was predominance of lumbar paravertebral contracture, as well as in palpation of this region. In neurological examination there weren't alterations. The multi-scan computed axial tomography and the spine column bone scintigraphy confirmed the diagnosis. Medical treatment was prescribed based on symptoms, combined antibiotic drug therapy and external orthesis. The total recovery of patient occurred at 6 months from the onset of diseases(AU)